Asian Pacific Association of Gastroenterology (APAGE) Clinical Practice Guidelines on the Use of Small Molecules and IL‐23 p19 Inhibitors in Ulcerative Colitis and Crohn's Disease
Ulcerative colitis (UC) and Crohn's disease (CD) are increasingly prevalent in the Asia Pacific region, necessitating updated, region-specific guidance on advanced therapies. Targeted small molecule agents, such as filgotinib, tofacitinib, upadacitinib, etrasimod, and ozanimod; and the IL-23 p19 inhibitors (guselkumab, mirikizumab, risankizumab) are the newest advanced therapies in our armamentarium for the treatment of IBD. The aim of the Asia-Pacific consensus statements is to provide context-specific recommendations integrating real-world evidence specific to our region. The Asian-Pacific Association of Gastroenterology (APAGE) Committee on Inflammatory Bowel Disease, with the participation of Asian Education Network in Inflammatory Bowel Disease (AEN-IBD), convened a forum of 34 IBD experts from 12 countries to develop consensus guidelines on the best practices on the use of these new advanced therapies using the modified Delphi method. IL-23 p19 inhibitors have shown good efficacy in biologic-naïve and experienced patients in both UC and CD, with clinical and endoscopic superiority over ustekinumab and an excellent safety profile. JAK inhibitors (tofacitinib and filgotinib) are efficacious in UC, and upadacitinib is efficacious in both UC and CD. They have a rapid time to response, and emerging data on acute severe UC appears promising. However, careful screening and monitoring is needed for known side effects, and prophylactic vaccination for herpes zoster should be considered. S1P modulators (ozanimod, etrasimod) are efficacious in UC with a favorable side effect profile.
Authors
- Luan Minh Dang (ORCID: https://orcid.org/0000-0002-9295-4308)
- Julajak Limsrivilai (ORCID: https://orcid.org/0000-0001-5867-0312)
- Meng‐Tzu Weng (ORCID: https://orcid.org/0000-0002-4143-6607)
- Ida Hilmi (ORCID: https://orcid.org/0000-0001-7091-0032)
- Marcellus Simadibrata (ORCID: https://orcid.org/0000-0003-1131-5836)
- Pises Pisespongsa (ORCID: https://orcid.org/0000-0002-3181-546X)
- Raja Affendi Raja Ali (ORCID: https://orcid.org/0000-0003-4995-3868)
- Rupert W. Leong (ORCID: https://orcid.org/0000-0001-5944-3488)
- Wee Chian Lim (ORCID: https://orcid.org/0000-0001-8801-1342)
- Alex Hwong‐Ruey Leow (ORCID: https://orcid.org/0000-0003-1752-0435)
- Wan Chee Ong (ORCID: https://orcid.org/0000-0001-6733-9162)
- Joyce Wing Yan Mak (ORCID: https://orcid.org/0000-0001-5221-7349)
- Choon Jin Ooi (ORCID: https://orcid.org/0000-0001-8961-5455)
- Nik Razima Wan Ibrahim
- Satimai Aniwan (ORCID: https://orcid.org/0000-0002-2730-2450)
- Malcolm Tan
- Huiyu Lin (ORCID: https://orcid.org/0000-0001-8779-6010)
- Zhi Hua Ran (ORCID: https://orcid.org/0000-0001-6388-6206)
- Wai-keung Leung
- Khoon Lin Ling (ORCID: https://orcid.org/0000-0002-2931-4666)
- Hang Dao Viet
- S C Wei
- Wei Jie Jonathan Lee
- Vineet Ahuja (ORCID: https://orcid.org/0000-0002-1577-0118)
- Katsuyoshi Matsuoka (ORCID: https://orcid.org/0000-0002-2950-7660)
- Govind Makharia (ORCID: https://orcid.org/0000-0002-2474-2194)
- Kai Chun Wu
- Taku Kobayashi (ORCID: https://orcid.org/0000-0002-2073-4234)
- Ryota Hokari
- Nazri Mustaffa
- Byong Duk Ye
- Jose Sollano
- Mathew Philip (ORCID: https://orcid.org/0000-0002-7820-4877)
- Siew‐Chien Ng (ORCID: https://orcid.org/0000-0002-6850-4454)
Institutions
- Toho University (JP)
- Siriraj Hospital (TH)
- Universiti Sains Malaysia (MY)
- Chulalongkorn University (TH)
- National University of Singapore (SG)
- Chinese University of Hong Kong (HK)
- Hanoi Medical University (VN)
- Singapore General Hospital (SG)
- Mahidol University (TH)
- Hospital Kuala Lumpur (MY)
- Concord Repatriation General Hospital (AU)
- Asan Medical Center (KR)
- Tan Tock Seng Hospital (SG)
- University of Medicine and Pharmacy at Ho Chi Minh City (VN)
- University of Indonesia (ID)
- University of Malaya (MY)
- University of Ulsan (KR)
- Lourdes Hospital (IN)
- Hospital Universiti Sains Malaysia (MY)
- Toho University Medical Center Sakura Hospital (JP)
- Duke-NUS Medical School (SG)
- Pixel Magic Systems (China) (CN)
- National Taiwan University Hospital (TW)
- Shanghai University of Medicine and Health Sciences (CN)
- National University Health System (SG)
- Kitasato Institute Hospital (JP)
- Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo (ID)
- Xijing Hospital (CN)
- KPJ Ampang Puteri Specialist Hospital (MY)
- National Defense Medical College (JP)
- All India Institute of Medical Sciences (IN)
- University of Santo Tomas (PH)
- Sunway University (MY)
- Singapore University of Social Sciences (SG)
- National University of Malaysia (MY)
- University of Hong Kong (HK)
- King Mongkut's Institute of Technology Ladkrabang (TH)
- Air Force Medical University (CN)
Publication Details
- Journal
- Journal of Gastroenterology and Hepatology
- Published
- 2026-05-12
- DOI
- https://doi.org/10.1111/jgh.70379
- Primary Topic
- Inflammatory Bowel Disease
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Ferring
- Journal of Gastroenterology and Hepatology Foundation